Sutures are widely used within patients to secure two or more layers of soft tissue together, or to secure soft tissue to bone. During open procedures in which a large incision provides ready access to the tissues, surgeons have little difficulty in passing suture to the surgical site and then retrieving or withdrawing the suture to provide two free ends on either side of the tissue. The two ends of suture thereafter are knotted, or utilized for additional suturing of the tissue.
There are an increasing number of closed procedures conducted through one or more cannulas. Access to tissues is provided through narrow passageways within the cannulas. During some endoscopic and arthroscopic procedures, suture is delivered through a first cannula using an elongated needle and threaded through one side of the tissue. Thereafter, the suture must be retrieved through a second cannula using narrow grasper-type forceps or an elongated hollow suture retriever having an internal wire loop. The wire loop is extendable beyond the tip of the retriever to capture a free end of the suture. While graspers can grab a middle portion of a suture, the wire loop of the suture retriever can only be passed around a free end of the suture. Therefore, two or more instruments typically are required to perform endoscopic or arthroscopic suturing.
Several devices having an eye or groove for placing a suture through tissue are disclosed in U.S. Pat. No. 5,222,977 (Esser) and U.S. Pat. No. 5,281,237 (Gimpelson). Other instruments which deliver suture internally through the instrument, and methods of using same, are disclosed in U.S. Pat. No. 4,923,461 (Caspari, et al.) and U.S. Pat. No. 4,935,027 (Yoon), for example.
Instruments with two or more grasping elements are presently used in other surgical fields such as for retrieving gall stones. In nonsurgical fields, object retrievers are sold in certain hardware stores for retrieving screws, nuts and other items. Also available are pickle tongs having three or four wires which are protrudable to grasp a pickle from a jar.